Original Article
Re-irradiation in recurrent rectal cancer: single institution experience
Abstract
Purpose: To determine the rates of acute and late toxicity, the efficacy to relieve symptoms, progression free survival, and over all survival in rectal cancer patients treated with re-irradiation.
Patients and methods: Between June 2009 and December 2012, 32 patients with recurrent rectal cancer previously treated with pelvic irradiation, were treated with 180 cGy/fraction, with a total dose 39 Gy if the treatment interval ≥1 year, and 30 Gy if interval <1 year. The dose was delivered to planning target volume (PTV) including gross target volume plus 2-3 cm margin. Concurrent chemotherapy was administrated in first five days of radiotherapy. Patients were evaluated during and after completion of treatment for acute, late toxicity, and response.
Results: Re-irradiation was well tolerated, no grade 4 toxicity was recorded, most toxicities were mild (grade 1-2), only 6.2% developed grade 3 acute gastrointestinal and 6.2% developed grade 3 late skin toxicity. Symptoms were effectively palliated, bleeding was relieved in 100%, and 80% recovered of pain symptoms. Two years rates of progression free survival and overall survival were 21% and 38% respectively. Interval to reirradiation, previous radiation dose, and total radiation dose showed significant relation with overall survival.
Conclusions: Re-irradiation in recurrent rectal cancer was well tolerated with mild rates of acute and late toxicities. Bleeding and pain were well controlled.
Patients and methods: Between June 2009 and December 2012, 32 patients with recurrent rectal cancer previously treated with pelvic irradiation, were treated with 180 cGy/fraction, with a total dose 39 Gy if the treatment interval ≥1 year, and 30 Gy if interval <1 year. The dose was delivered to planning target volume (PTV) including gross target volume plus 2-3 cm margin. Concurrent chemotherapy was administrated in first five days of radiotherapy. Patients were evaluated during and after completion of treatment for acute, late toxicity, and response.
Results: Re-irradiation was well tolerated, no grade 4 toxicity was recorded, most toxicities were mild (grade 1-2), only 6.2% developed grade 3 acute gastrointestinal and 6.2% developed grade 3 late skin toxicity. Symptoms were effectively palliated, bleeding was relieved in 100%, and 80% recovered of pain symptoms. Two years rates of progression free survival and overall survival were 21% and 38% respectively. Interval to reirradiation, previous radiation dose, and total radiation dose showed significant relation with overall survival.
Conclusions: Re-irradiation in recurrent rectal cancer was well tolerated with mild rates of acute and late toxicities. Bleeding and pain were well controlled.
